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General NPI Number Information
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NPI Number | 1801266978
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Entity Type | Individual
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Provider Name | KARLA BRUNTZEL
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 500 E COLLEGE ST
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City | MARSHALL
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State | MO
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Zip | 65340-3109
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Country | US
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Telephone | 660-886-8772
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Fax |
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Provider Business Mailing Address
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Address Line | 604 W HILLSIDE DR
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City | MARSHALL
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State | MO
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Zip | 65340-2423
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Country | US
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Telephone | 660-815-1315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 2000171998
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License Number State | MO
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